重症哮喘患者在急性发作后几天内可能导致气管不同程度的阻塞。 出院带药应该反映这一点,包括考虑到长期的口服应用糖皮质激素(OCS)。 出院后大剂量吸入糖皮质激素(ICS)作为口服激素的替代或辅助,其作用尚未明确。 有证据显示,在轻度哮喘患者中,大剂量的吸入糖皮质激素与口服糖皮质激素可能是等效的,但需要更多更强的证据支持。[111]Edmonds ML, Milan SJ, Brenner BE, et al. Inhaled steroids for acute asthma following emergency department discharge. Cochrane Database Syst Rev. 2012;(12):CD002316.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD002316.pub2/fullhttp://www.ncbi.nlm.nih.gov/pubmed/10908556?tool=bestpractice.com[112]Edmonds ML, Milan SJ, Camargo-Jr CA, et al. Early use of inhaled corticosteroids in the emergency department treatment of acute asthma. Cochrane Database Syst Rev. 2012;(12):CD002308.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD002308.pub2/fullhttp://www.ncbi.nlm.nih.gov/pubmed/23235589?tool=bestpractice.com [
]In people discharged from the emergency department following treatment for acute asthma, what are the benefits and harms of inhaled steroids?https://cochranelibrary.com/cca/doi/10.1002/cca.158/full显示答案 如果症状加重,应该立即进行临床再评估,必要时住院治疗。主治医师应在患者从急诊室或者住院部出院3-5天内进行随访,评估哮喘方案是否能对该患者有效控制。出院前对患儿出院后1-4周内的哮喘随访进行安排。症状监测是最合适的监测方法。峰流速监测可能对掌握这项技术、且其父母或患儿本身对哮喘症状认识较差者有一定作用。另外,加强控制其他相关合并症,如过敏性鼻炎,可能对于哮喘的控制也有帮助。[113]Bousquet J, Khaltaev N, Cruz AA, et al. Allergic rhinitis and its impact on asthma (ARIA): 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy. 2008;63:8-160.http://onlinelibrary.wiley.com/doi/10.1111/j.1398-9995.2007.01620.x/fullhttp://www.ncbi.nlm.nih.gov/pubmed/18331513?tool=bestpractice.com